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Muthui R, Paun O. Process of Advance Care Planning in Nursing Home Settings: An Integrative Literature Review. Res Gerontol Nurs 2022; 15:312-320. [PMID: 36214735 DOI: 10.3928/19404921-20220930-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Advance care planning (ACP) allows individuals to communicate their wishes for future medical care. ACP is particularly important among those diagnosed with Alzheimer's disease and related dementias (ADRD) due to decline in cognition. In the nursing home setting, conducting ACP with residents with ADRD and their family caregivers is challenging. The purpose of the current integrative review was to: (a) examine the evidence on the process of conducting ACP with residents with ADRD and their family caregivers in nursing home settings, and (b) understand who conducts ACP and when and how ACP is being conducted with residents with ADRD and their family caregivers. Gaps were identified, such as lack of a systematic approach to addressing ACP in nursing homes, lack of clear roles in conducting ACP, family caregivers' and nursing home staff's lack of knowledge and skills to engage in ACP, and lack of diversity in study samples. To improve clinical practice, future studies should explore standardization of the ACP process in the nursing home setting. [Research in Gerontological Nursing, xx(x), xx-xx.].
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Vogelsmeier A, Popejoy L, Fritz E, Canada K, Ge B, Brandt L, Rantz M. Repeat hospital transfers among long stay nursing home residents: a mixed methods analysis of age, race, code status and clinical complexity. BMC Health Serv Res 2022; 22:626. [PMID: 35538575 PMCID: PMC9087933 DOI: 10.1186/s12913-022-08036-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background Nursing home residents are at increased risk for hospital transfers resulting in emergency department visits, observation stays, and hospital admissions; transfers that can also result in adverse resident outcomes. Many nursing home to hospital transfers are potentially avoidable. Residents who experience repeat transfers are particularly vulnerable to adverse outcomes, yet characteristics of nursing home residents who experience repeat transfers are poorly understood. Understanding these characteristics more fully will help identify appropriate intervention efforts needed to reduce repeat transfers. Methods This is a mixed-methods study using hospital transfer data, collected between 2017 and 2019, from long-stay nursing home residents residing in 16 Midwestern nursing homes who transferred four or more times within a 12-month timeframe. Data were obtained from an acute care transfer tool used in the Missouri Quality Initiative containing closed- and open-ended questions regarding hospital transfers. The Missouri Quality Initiative was a Centers for Medicare and Medicaid demonstration project focused on reducing avoidable hospital transfers for long stay nursing home residents. The purpose of the analysis presented here is to describe characteristics of residents from that project who experienced repeat transfers including resident age, race, and code status. Clinical, resident/family, and organizational factors that influenced transfers were also described. Results Findings indicate that younger residents (less than 65 years of age), those who were full-code status, and those who were Black were statistically more likely to experience repeat transfers. Clinical complexity, resident/family requests to transfer, and lack of nursing home resources to manage complex clinical conditions underlie repeat transfers, many of which were considered potentially avoidable. Conclusions Improved nursing home resources are needed to manage complex conditions in the NH and to help residents and families set realistic goals of care and plan for end of life thus reducing potentially avoidable transfers.
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Affiliation(s)
- Amy Vogelsmeier
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA.
| | - Lori Popejoy
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Elizabeth Fritz
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Kelli Canada
- School of Social Work, University of Missouri, Columbia, MO, USA
| | - Bin Ge
- School of Medicine, University of Missouri, Columbia, MO, USA
| | - Lea Brandt
- School of Medicine, University of Missouri, Columbia, MO, USA
| | - Marilyn Rantz
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
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Popejoy LL, Vogelsmeier AA, Canada KE, Kist S, Miller SJ, Galambos C, Alexander GL, Crecelius C, Rantz M. A Call to Address RN, Social Work, and Advanced Practice Registered Nurses in Nursing Homes: Solutions From the Missouri Quality Initiative. J Nurs Care Qual 2022; 37:21-27. [PMID: 34751164 PMCID: PMC8608010 DOI: 10.1097/ncq.0000000000000604] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND US nursing homes (NHs) have struggled to overcome a historic pandemic that laid bare limitations in the number and clinical expertise of NH staff. PROBLEM For nurse staffing, current regulations require only one registered nurse (RN) on duty 8 consecutive hours per day, 7 days per week, and one RN on call when a licensed practical/vocational nurse is on duty. There is no requirement for a degreed or licensed social worker, and advanced practice registered nurses (APRNs) in NHs cannot bill for services. APPROACH It is time to establish regulation that mandates a 24-hour, 7-day-a-week, on-site RN presence at a minimum requirement of 1 hour per resident-day that is adjusted upward for greater resident acuity and complexity. Skilled social workers are needed to improve the quality of care, and barriers for APRN billing for services in NHs need to be removed. CONCLUSIONS Coupling enhanced RN and social work requirements with access to APRNs can support staff and residents in NHs.
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Affiliation(s)
- Lori L. Popejoy
- Sinclair School of Nursing, University of Missouri, Columbia (Drs Popejoy, Vogelsmeier, Canada, Kist, and Rantz and Mr Miller); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee (Dr Galambos); Columbia University School of Nursing, New York City, New York (Dr Alexander); Washington University School of Medicine, St Louis, Missouri (Dr Crecelius); and BJC Medical Group, St Louis, Missouri (Dr Crecelius)
| | - Amy A. Vogelsmeier
- Sinclair School of Nursing, University of Missouri, Columbia (Drs Popejoy, Vogelsmeier, Canada, Kist, and Rantz and Mr Miller); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee (Dr Galambos); Columbia University School of Nursing, New York City, New York (Dr Alexander); Washington University School of Medicine, St Louis, Missouri (Dr Crecelius); and BJC Medical Group, St Louis, Missouri (Dr Crecelius)
| | - Kelli E. Canada
- Sinclair School of Nursing, University of Missouri, Columbia (Drs Popejoy, Vogelsmeier, Canada, Kist, and Rantz and Mr Miller); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee (Dr Galambos); Columbia University School of Nursing, New York City, New York (Dr Alexander); Washington University School of Medicine, St Louis, Missouri (Dr Crecelius); and BJC Medical Group, St Louis, Missouri (Dr Crecelius)
| | - Shari Kist
- Sinclair School of Nursing, University of Missouri, Columbia (Drs Popejoy, Vogelsmeier, Canada, Kist, and Rantz and Mr Miller); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee (Dr Galambos); Columbia University School of Nursing, New York City, New York (Dr Alexander); Washington University School of Medicine, St Louis, Missouri (Dr Crecelius); and BJC Medical Group, St Louis, Missouri (Dr Crecelius)
| | - Steven J. Miller
- Sinclair School of Nursing, University of Missouri, Columbia (Drs Popejoy, Vogelsmeier, Canada, Kist, and Rantz and Mr Miller); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee (Dr Galambos); Columbia University School of Nursing, New York City, New York (Dr Alexander); Washington University School of Medicine, St Louis, Missouri (Dr Crecelius); and BJC Medical Group, St Louis, Missouri (Dr Crecelius)
| | - Colleen Galambos
- Sinclair School of Nursing, University of Missouri, Columbia (Drs Popejoy, Vogelsmeier, Canada, Kist, and Rantz and Mr Miller); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee (Dr Galambos); Columbia University School of Nursing, New York City, New York (Dr Alexander); Washington University School of Medicine, St Louis, Missouri (Dr Crecelius); and BJC Medical Group, St Louis, Missouri (Dr Crecelius)
| | - Gregory L. Alexander
- Sinclair School of Nursing, University of Missouri, Columbia (Drs Popejoy, Vogelsmeier, Canada, Kist, and Rantz and Mr Miller); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee (Dr Galambos); Columbia University School of Nursing, New York City, New York (Dr Alexander); Washington University School of Medicine, St Louis, Missouri (Dr Crecelius); and BJC Medical Group, St Louis, Missouri (Dr Crecelius)
| | - Charles Crecelius
- Sinclair School of Nursing, University of Missouri, Columbia (Drs Popejoy, Vogelsmeier, Canada, Kist, and Rantz and Mr Miller); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee (Dr Galambos); Columbia University School of Nursing, New York City, New York (Dr Alexander); Washington University School of Medicine, St Louis, Missouri (Dr Crecelius); and BJC Medical Group, St Louis, Missouri (Dr Crecelius)
| | - Marilyn Rantz
- Sinclair School of Nursing, University of Missouri, Columbia (Drs Popejoy, Vogelsmeier, Canada, Kist, and Rantz and Mr Miller); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee (Dr Galambos); Columbia University School of Nursing, New York City, New York (Dr Alexander); Washington University School of Medicine, St Louis, Missouri (Dr Crecelius); and BJC Medical Group, St Louis, Missouri (Dr Crecelius)
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Galambos C, Vogelsmeier A, Popejoy L, Crecelius C, Canada K, Alexander GL, Rollin L, Rantz M. Enhancing Physician Relationships, Communication, and Engagement to Reduce Nursing Home Residents Hospitalizations. J Nurs Care Qual 2021; 36:99-104. [PMID: 33534347 DOI: 10.1097/ncq.0000000000000542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Colleen Galambos
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee (Dr Galambos and Ms Rollin); Sinclair School of Nursing (Drs Vogelsmeier, Popejoy, Crecelius, and Rantz) and School of Social Work (Dr Canada), University of Missouri, St Louis; and Columbia University, School of Nursing (Dr Alexander)
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Fulmer T, Reuben DB, Auerbach J, Fick DM, Galambos C, Johnson KS. Actualizing Better Health And Health Care For Older Adults. Health Aff (Millwood) 2021; 40:219-225. [DOI: 10.1377/hlthaff.2020.01470] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Terry Fulmer
- Terry Fulmer is president and CEO of the John A. Hartford Foundation, in New York, New York
| | - David B. Reuben
- David B. Reuben is director of the Multicampus Program in Geriatrics Medicine and Gerontology and chief of the Division of Geriatrics at the University of California Los Angeles Center for Health Sciences, in Los Angeles, California
| | - John Auerbach
- John Auerbach is president and CEO of Trust for America’s Health, in Washington, D.C
| | - Donna Marie Fick
- Donna Marie Fick is director of the Center of Geriatric Nursing Excellence in the College of Nursing at the Pennsylvania State University, in University Park, Pennsylvania
| | - Colleen Galambos
- Colleen Galambos is the Helen Bader Endowed Chair of applied gerontology at the University of Wisconsin–Milwaukee, in Milwaukee, Wisconsin
| | - Kimberly S. Johnson
- Kimberly S. Johnson is an associate professor in the Division of Geriatrics at the Duke University School of Medicine, in Durham, North Carolina
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Galambos C, Rantz M, Popejoy L, Ge B, Petroski G. Advance Directives in the Nursing Home Setting: An Initiative to Increase Completion and Reduce Potentially Avoidable Hospitalizations. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2021; 17:19-34. [PMID: 33491595 DOI: 10.1080/15524256.2020.1863895] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Advance directive (AD) completion can improve transitions between hospitals and skilled nursing facilities (SNF's). One Centers for Medicare and Medicaid Services (CMS) Innovations Demonstration Project, The Missouri Quality Initiative (MOQI), focused on improving AD documentation and use in sixteen SNF's. The intervention included education, training, consultation and improvements to discussion process, policy development, increased AD enactment, and increased community education and awareness activities. An analysis was conducted of data collected from annual chart inventories occurring over four years. Using a logistic mixed model, results indicated statistical significance (p < .001) for increased AD documentation. Greatest gains occurred at project mid-point. The relationship between having an AD and occurrence of transfer to a hospital was tested on a sample of 1,563 residents with length of stays more than 30 days. Residents who did not have an AD were 29% more likely to be transferred. A logistic regression was conducted, and the results were statistically significant (p < .02).
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Affiliation(s)
- Colleen Galambos
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Marilyn Rantz
- Sinclair School of Nursing, University of Missouri, Missouri, Columbia, USA
| | - Lori Popejoy
- Sinclair School of Nursing, University of Missouri, Missouri, Columbia, USA
| | - Bin Ge
- School of Medicine, University of Missouri, Missouri, Columbia, USA
| | - Greg Petroski
- School of Medicine, University of Missouri, Missouri, Columbia, USA
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Rantz M, Petroski GF, Popejoy LL, Vogelsmeier AA, Canada KE, Galambos C, Alexander GL, Crecelius C. Longitudinal Impact of APRNs on Nursing Home Quality Measures in the Missouri Quality Initiative. J Nutr Health Aging 2021; 25:1124-1130. [PMID: 34725672 PMCID: PMC8485110 DOI: 10.1007/s12603-021-1684-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 12/02/2022]
Abstract
OBJECTIVES To measure the impact of advanced practice nurses (APRNs) on quality measures (QM) scores of nursing homes (NHs) in the CMS funded Missouri Quality Initiative (MOQI) that was designed to reduce avoidable hospitalizations of NH residents, improve quality of care, and reduce overall healthcare spending. DESIGN A four group comparative analysis of longitudinal data from September 2013 thru December 2019. SETTING NHs in the interventions of both Phases 1 (2012-2016) and 2 (2016-2020) of MOQI (n=16) in the St. Louis area; matched comparations in the same counties as MOQI NHs (n=27); selected Phase 2 payment intervention NHs in Missouri (n=24); NHs in the remainder of the state (n=406). PARTICIPANTS NHs in Missouri Intervention: Phase 1 of The Missouri Quality Initiative (MOQI), a Centers for Medicare and Medicaid (CMS) Innovations Center funded research initiative, was a multifaceted intervention in NHs in the Midwest, which embedded full-time APRNs in participating NHs to reduce hospitalizations and improve care of NH residents. Phase 2 extended the MOQI intervention in the original intervention NHs and added a CMS designed Payment Intervention; Phase 2 added a second group of NHs to receive the Payment. Intervention Only. MEASUREMENTS Eight QMs selected by CMS for the Initiative were falls, pressure ulcers, urinary tract infections, indwelling catheters, restraint use, activities of daily living, weight loss, and antipsychotic medication use. For each of the monthly QMs (2013 thru 2019) an unobserved components model (UCM) was fitted for comparison of groups. RESULTS The analysis of QMs reveals that that the MOQI Intervention + Payment group (group with the embedded APRNs) out-performed all comparison groups: matched comparison with neither intervention, Payment Intervention only, and remainder of the state. CONCLUSION These results confirm the QM analyses of Phase 1, that MOQI NHs with full-time APRNs are effective to improve quality of care.
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Affiliation(s)
- M Rantz
- Marilyn Rantz, University of Missouri Sinclair School of Nursing, Columbia, Missouri, USA
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Vogelsmeier A, Popejoy L, Canada K, Galambos C, Petroski G, Crecelius C, Alexander GL, Rantz M. Results of the Missouri Quality Initiative in Sustaining Changes in Nursing Home Care: Six-Year Trends of Reducing Hospitalizations of Nursing Home Residents. J Nutr Health Aging 2021; 25:5-12. [PMID: 33367456 DOI: 10.1007/s12603-020-1552-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The purpose of this article is to present six-year findings of the Missouri Quality Initiative (MOQI) to reduce unnecessary hospitalizations for long-stay nursing home residents. DESIGN A CMS funded demonstration project analyzed over 6-years using a single group design. SETTING AND PARTICIPANTS The setting was 16 Midwestern US nursing homes ranging in size between 121 and 321 beds located in urban and rural areas in one geographic region. The sample of eligible residents averaged from 1819 in 2014 to 1068 in 2019. MEASURES Resident data were analyzed using descriptive methods of aggregate facilities' hospital transfer rates per 1000 resident days and changes per year of average hospital transfer rates. Individual facility transfer rates were grouped by level of performance (best, mixed, and low). Leadership turnover and engagement were also described. INTERVENTION Full-time advanced practice registered nurses (APRN) and an operations support team focused on reducing unnecessary hospitalizations for long-stay nursing home residents. RESULTS Total transfers for 2014-2019 was 6913 and the average transfer rate per 1000 resident days declined from 2.48 in 2014 to a low of 1.89 in 2018 and slightly increased to 1.99 in 2019. Eleven nursing homes achieved sustained improvement, five did not. Differences in leadership turnover and engagement were noted by level of performance; however, three outlier facilities were identified. CONCLUSIONS/IMPLICATIONS The MOQI intervention achieved improved outcomes over six-years in the majority of nursing homes in the project. The embedded APRN's daily focus on project goals supported by a multi-disciplinary operations team facilitated success. Facility leadership stability and engagement in the project likely contributed to outcomes. Full-time presence of APRNs coupled with an operations' support team improved nursing homes outcomes, however Medicare currently restricts APRNs hired by nursing homes from billing Medicare for direct care services. This unnecessary restriction of practice discourages nursing homes from hiring APRNs and should be abolished.
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Affiliation(s)
- A Vogelsmeier
- Amy Vogelsmeier PhD, RN, FAAN, S421 Sinclair School of Nursing, Columbia, MO 65211,
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Chua TH, Foong JRJ, Tan RR, Rukasha PN, Hullick C. Assessment of advance care planning documentation for residents of residential aged care facilities presenting to the emergency department. AUST HEALTH REV 2020; 44:847-852. [PMID: 33213690 DOI: 10.1071/ah19238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/12/2020] [Indexed: 11/23/2022]
Abstract
Objective This study assessed the availability and quality of advance care planning (ACP) documentation among older residential aged care facility (RACF) residents who presented to the emergency department (ED). Methods A prospective review of the medical records of RACF residents aged ≥75 years who presented to the ED from May to June 2018 was conducted. Availability of ACP was determined based on the presence of an ACP document inclusive of an advance care directive (ACD) in the medical record. The quality of ACP documentation was determined based on the presence of nine key components. Results In all, 48.8% of patients presented to the ED with either ACP or an ACD. However, only a mean total of 3.8 (out of 9) ACP components were documented in these documents. Conclusions Just under half (48.8%) of RACF residents presented to the ED with ACP documentation. There was limited coverage of core ACP components needed to guide clinical decision making. What is known about the topic? RACF residents are in the last years of their life and commonly lack capacity to make decisions regarding health care. Residents are at high risk of dying when acutely unwell in hospital. ACP documentation, when readily available, helps provide appropriate end-of-life care and improves both patient and family satisfaction. What does this paper add? Less than half the residents reporting to the ED from an RACF had ACP documentation available for clinicians. For those who presented to the ED with ACP documentation, most lacked sufficient information needed to provide care in full accordance with the patient's preferences. What are the implications for practitioners? There is a need to encourage, initiate, actively engage and develop systems for ACP conversations, documentation and availability when acutely unwell for people living in RACFs to provide sufficient information to guide clinical decision making. Without quality ACP, the provision of patient-centred health care may be compromised.
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Affiliation(s)
- Tzy Harn Chua
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. ; ; ;
| | - Jessica Ru-Jia Foong
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. ; ; ;
| | - Ryan Renxin Tan
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. ; ; ;
| | - Princess Natsai Rukasha
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. ; ; ;
| | - Carolyn Hullick
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. ; ; ; ; and Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; and Belmont Hospital, Croudace Bay Road, Belmont, NSW 2280, Australia; and Corresponding author.
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Glennon CA, Thomas W, Black K, Herrig M, Ishikawa J, Reedy I. Educating Healthcare Employees about Advance Care Planning. Asia Pac J Oncol Nurs 2019; 6:343-348. [PMID: 31572753 PMCID: PMC6696800 DOI: 10.4103/apjon.apjon_27_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/16/2019] [Indexed: 11/04/2022] Open
Abstract
The objective of this descriptive article is to provide a background of current research and data on advance care planning. Additionally, a proposed and detailed education initiative for increasing completion and understanding of advance care planning documents is presented.
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Affiliation(s)
| | - Wendy Thomas
- The University of Kansas Cancer Center, Westwood, KS, USA
| | - Katherine Black
- University of Kansas Medical Center, Department of Occupational Therapy Education, Kansas City, KS, USA
| | - Madison Herrig
- University of Kansas Medical Center, Department of Occupational Therapy Education, Kansas City, KS, USA
| | - Jane Ishikawa
- University of Kansas Medical Center, Department of Occupational Therapy Education, Kansas City, KS, USA
| | - Isabel Reedy
- University of Kansas Medical Center, Department of Occupational Therapy Education, Kansas City, KS, USA
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Rantz MJ, Popejoy L, Vogelsmeier A, Galambos C, Alexander G, Flesner M, Murray C, Crecelius C. Reducing Avoidable Hospitalizations and Improving Quality in Nursing Homes With APRNs and Interdisciplinary Support: Lessons Learned. J Nurs Care Qual 2019; 33:5-9. [PMID: 28968340 DOI: 10.1097/ncq.0000000000000302] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Marilyn J Rantz
- MU Sinclair School of Nursing (Drs Rantz, Popejoy, Vogelsmeier, Alexander, Flesner, Murray, and Crecelius), and Department of Social Work, College of Human and Environmental Sciences (Dr Galambos), University of Missouri, Columbia. Dr Crecelius is on-site in grant operation location, St Louis, Missouri
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The APRN Role in Changing Nursing Home Quality: The Missouri Quality Improvement Initiative. J Nurs Care Qual 2019; 32:196-201. [PMID: 28505060 DOI: 10.1097/ncq.0000000000000264] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Folarinde B, Alexander GL, Galambos C, Wakefield BJ, Vogelsmeier A, Madsen RW. Exploring Perceptions of Health Care Providers' Use of Electronic Advance Directive Forms in Electronic Health Records. J Gerontol Nurs 2019; 45:17-21. [PMID: 30653233 DOI: 10.3928/00989134-20190102-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The current study explored the perceptions of health care providers' use of electronic advance directive (AD) forms in the electronic health record (EHR). The Technology Acceptance Model (TAM) was used to guide the study. Of 165 surveys distributed, 151 participants (92%) responded. A moderately strong positive correlation was noted between perceived usefulness and actual system usage (r = 0.70, p < 0.0001). Perceived ease of use and actual system usage also had a moderately strong positive correlation (r = 0.70, p < 0.0001). In contrast, the strength of the relationship between behavioral intention to use and actual system usage was more modest (r = 0.22, p < 0.004). There was a statistically significant difference in actual system usage of electronic ADs across six departments (χ2[5] = 79.325, p < 0.001). The relationships among primary TAM constructs found in this research are largely consistent with previous TAM studies, with the exception of behavioral intention to use, which is slightly lower. These data suggest that health care providers' perceptions have great influence on the use of electronic ADs. [Journal of Gerontological Nursing, 45(1), 17-21.].
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Hold J, Payne C, Lesandrini J, Glover AC. Successful Advance Care Planning in a Rural Nursing Home. Am J Hosp Palliat Care 2018; 36:357-361. [PMID: 30428679 DOI: 10.1177/1049909118812162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND: Advance care planning (ACP) often culminates in the completion of advance care directives (ACD), which is a written record of informed decisions specifying the type and extent of desired medical treatment. Documentation of ACD in nursing homes in the United States indicates a 60% to 70% completion rate. There are little data on the time at which ACD are completed in relation to when the resident was admitted to the nursing home facility. OBJECTIVE: To explore the success of advanced care planning at a large, rural long-term care (LTC) facility. METHODS: A descriptive approach, using a retrospective chart review, of 167 residents was used to examine resident completion of health-care system documents, legal documents, predisposing factors (resident demographics and psychosocial characteristics), and the actual process of ACP as defined by the rural LTC facility. RESULTS: This nursing home utilizes a document entitled resident preference for life-sustaining treatment (RPLST). For residents who do not have formal prepared advance directive documents, the RPLST serves to define resident and family choices for resuscitation and implementation of fluids, nutrition, medications, and antibiotics. The most striking finding was the completion rate of the RPLST within 100 days of being admitted to the nursing home. CONCLUSION: Documentation of end-of-life preferences within 10 days of admission was achieved through the incorporation of RPLST during the resident admission process.
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Affiliation(s)
- Judith Hold
- 1 Wellstar School of Nursing Kennesaw State University, Kennesaw, GA, USA
| | - Camille Payne
- 1 Wellstar School of Nursing Kennesaw State University, Kennesaw, GA, USA
| | | | - Avery Caz Glover
- 3 Department of Religious Studies, Georgia State University, Atlanta, GA, USA
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Fougère B, Lagourdette C, Abele P, Resnick B, Rantz M, Kam Yuk Lai C, Chen Q, Moyle W, Vellas B, Morley JE. Involvement of Advanced Practice Nurse in the Management of Geriatric Conditions: Examples from Different Countries. J Nutr Health Aging 2018; 22:463-470. [PMID: 29582884 DOI: 10.1007/s12603-018-1008-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The increasing demand for healthcare services is placing great strain on healthcare systems throughout the world. Although the older population is increasing worldwide, there is a marked deficit in the number of persons trained in geriatrics. It is now recognized that early detection and treatment of geriatric conditions (e.g., frailty, sarcopenia, falls, anorexia of aging, and cognitive decline) will delay or avert the development of disability. At the same time, recent years have seen an increased interest and use of advanced practice nurses (APN). Models of best practices of supervision and collaboration have been promulgated by many organizations. APN's roles and scope of practice have been expanded in many countries and the quality and cost-effectiveness of healthcare systems have improved. Nevertheless, in older people, evidence of advanced practice roles remains scattered, and there is little synthesis of evidence, and therefore it is not easy to visualize the different practice models and their components. The aim of this paper is to explain the need for advanced practice nurses to manage geriatric conditions.
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Affiliation(s)
- B Fougère
- B. Fougère, Institut du Vieillissement, Gérontopôle, Université Toulouse III Paul Sabatier, 37 Allées Jules Guesde, 31000 Toulouse, France, Tel: +33561145657 ; fax: +33561145640, E-mail:
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Call to action: APRNs in U.S. nursing homes to improve care and reduce costs. Nurs Outlook 2017; 65:689-696. [DOI: 10.1016/j.outlook.2017.08.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/15/2017] [Accepted: 08/27/2017] [Indexed: 11/20/2022]
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18
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An Integrated Review of Research Using Clinical Decision Support to Improve Advance Directive Documentation. J Hosp Palliat Nurs 2017. [DOI: 10.1097/njh.0000000000000351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rantz MJ, Popejoy L, Vogelsmeier A, Galambos C, Alexander G, Flesner M, Crecelius C, Ge B, Petroski G. Successfully Reducing Hospitalizations of Nursing Home Residents: Results of the Missouri Quality Initiative. J Am Med Dir Assoc 2017; 18:960-966. [PMID: 28757334 DOI: 10.1016/j.jamda.2017.05.027] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 05/31/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE The goals of the Missouri Quality Initiative (MOQI) for long-stay nursing home residents were to reduce the frequency of avoidable hospital admissions and readmissions, improve resident health outcomes, improve the process of transitioning between inpatient hospitals and nursing facilities, and reduce overall healthcare spending without restricting access to care or choice of providers. The MOQI was one of 7 program sites in the United States, with specific interventions unique to each site tested for the Centers for Medicaid and Medicare Services (CMS) Innovations Center. DESIGN AND METHODS A prospective, single group intervention design, the MOQI included an advanced practice registered nurse (APRN) embedded full-time within each nursing home (NH) to influence resident care outcomes. Data were collected continuously for more than 3 years from an average of 1750 long-stay Medicare, Medicaid, and private pay residents living each day in 16 participating nursing homes in urban, metro, and rural communities within 80 miles of a major Midwestern city in Missouri. Performance feedback reports were provided to each facility summarizing their all-cause hospitalizations and potentially avoidable hospitalizations as well as a support team of social work, health information technology, and INTERACT/Quality Improvement Coaches. RESULTS The MOQI achieved a 30% reduction in all-cause hospitalizations and statistically significant reductions in 4 single quarters of the 2.75 years of full implementation of the intervention for long-stay nursing home residents. IMPLICATIONS As the population of older people explodes in upcoming decades, it is critical to find good solutions to deal with increasing costs of health care. APRNs, working with multidisciplinary support teams, are a good solution to improving care and reducing costs if all nursing home residents have access to APRNs nationwide.
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Affiliation(s)
- Marilyn J Rantz
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri.
| | - Lori Popejoy
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
| | - Amy Vogelsmeier
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
| | - Colleen Galambos
- Department of Social Work, College of Human and Environmental Sciences, University of Missouri, Columbia, Missouri
| | - Greg Alexander
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
| | - Marcia Flesner
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
| | - Charles Crecelius
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
| | - Bin Ge
- Office of Medical Research, School of Medicine, University of Missouri, Columbia, Missouri
| | - Gregory Petroski
- Office of Medical Research, School of Medicine, University of Missouri, Columbia, Missouri
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